Provider Demographics
NPI:1023438223
Name:KOLLER, ANNAMARIE (DO)
Entity type:Individual
Prefix:
First Name:ANNAMARIE
Middle Name:
Last Name:KOLLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 PENN SQUARE EAST
Mailing Address - Street 2:CHCA GENERAL PEDIATRICS
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107
Mailing Address - Country:US
Mailing Address - Phone:267-425-9200
Mailing Address - Fax:267-425-9299
Practice Address - Street 1:701 E MARSHALL ST
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4412
Practice Address - Country:US
Practice Address - Phone:610-431-5376
Practice Address - Fax:610-431-5527
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-27
Last Update Date:2018-11-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS018794208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1033657140001Medicaid